Overview of the COMPARE Project

Size: px

Start display at page:

Download "Overview of the COMPARE Project"

Margaret Harrington
5 years ago
Views:

1 MONASH MEDICINE, NURSING & HEALTH SCIENCES Overview of the COMPARE Project Professor Alex Collie Director, Insurance Work and Health Group, Faculty of Medicine Nursing and Health Sciences, Monash University

2 INSURANCE WORK AND HEALTH GROUP We exist to improve the health of all workers and the sustainability of the systems that insure them. Activities & Services Partners & Clients Data Research Advisory Workers Compensation Regulators & Insurers CTP Regulators & Insurers Life Insurers Employers Occupational Rehabilitation Providers Govt Social Services & Health 2

3 ACKNOWLEDGMENTS Funding The COMPARE Project is supported by funding from (1) WorkSafe Victoria through the Institute for Safety Compensation and Recovery Research; and (2) Safe Work Australia. Data The data used in the COMPARE Project is provided by (1) Comcare and by the following organisations via SafeWork Australia: (2) WorkSafe Victoria (3) WorkCover Tasmania (4) WorkCover WA (5) ReturnToWork SA, (6) State Insurance Regulatory Authority of NSW (7) Office of Industrial Relations, QLD Govt (8) ACT Government and (9) NT WorkSafe. Advisory Group The project advisory group includes representatives from the above organisations plus (1) the Australian Industry Group; and (2) the Australian Council of Trade Unions. Collaborators The project has academic collaborators from the University of British Columbia in Vancouver, Canada; the Institute of Work and Health in Toronto, Canada; and the University of Melbourne. 3

4 BACKGROUND Australian labour force = 11.5 million workers Nine major workers comp schemes = 10.8 million workers (SafeWork Australia, 2015) Self-reported work-related injury = 532,000 (est) (Australian Bureau of Statistics, 2015) Accepted workers compensation claims = ~242,000 (Lane T, et al, 2016) Annual cost estimated at $61.8B or 4.1% of GDP (SafeWork Australia, 2015) 4

YEARS LOST TO DISABILITY IN AUSTRALIA Working age Musculoskeletal disorders and mental health conditions are common in workers compensation schemes.

5 YEARS LOST TO DISABILITY IN AUSTRALIA Working age Musculoskeletal disorders and mental health conditions are common in workers compensation schemes. Mental Health Musculoskeletal These two conditions are responsible for the largest burden of years lost to disability in working age Australians. Effective prevention and rehabilitation / RTW has potential to dramatically improve population health. Australian Institute of Health and Welfare (2016)

6 FACTORS AFFECTING RETURN TO WORK Evidence-base is sparse Focus of COMPARE Project

7 AN EXAMPLE OF POLICY IMPACT STAND YOUR GROUND GUN LAWS IN THE STATE OF FLORIDA Rates of homicide by firearm in Florida increased at the same time that relaxed gun laws were introduced. Effect = ~20 additional homicides per month. The same change was not observed in four comparison states. 7 Source: Humphreys, Gasparrini, & Wiebe (2017). JAMA Intern Med, 177(1): 44-50

8 POLICY CAN BE A POWERFUL HEALTH INTERVENTION Policy effects can be: - Large - Population wide - Immediate - Long-lasting - Multi-dimensional Policy can have unintended consequences WHO Health in All Policies framework 8

9 AUSTRALIA PARADISE FOR RTW POLICY RESEARCH Nine major variations on workers compensation policy. Regular changes in rules governing scheme activity (legislation, regulation, policy, practice). A national minimum database of workers compensation data with a long time series. A national return to work survey of injured workers covering all workers compensation jurisdictions. A natural experiment! 9 9

10 COMPARE PROJECT RESEARCH OBJECTIVES 1. To determine the impact of workers compensation scheme policy on return to work and duration of time loss. 2. To identify policies that have positive and negative impact on return to work and duration of time loss. 10

11 OTHER IMPORTANT PROJECT AIMS 1. To develop a national workers compensation research data platform. 2. To extract insights and value from two existing national datasets. 3. To develop and test methods for assessing the impact of policy and policy change in Australian workers compensation systems. 4. To develop a research/industry collaboration that enables two-way knowledge exchange. 5. To build national capability in workers compensation and return to work research. 11

12 WHAT IS A COMPARATIVE RESEARCH DESIGN? 1. Compare outcomes between groups Between workers compensation jurisdictions Between occupations, age groups, injury types etc 2. Compare outcomes before-and-after an event 1. Before-and-after legislative amendment We attempt to isolate effects of policy by accounting for other factors Data / cohort selection Statistically 12

13 DATA OVERVIEW 1. National Dataset of Compensation Statistics 2. National RTW Survey 2003/4 to 2015/16 4,363,267 cases NSW, VIC, QLD, WA, TAS, SA, NT, ACT & CTH schemes Standardised coding for type of condition, occupation, industry. ABS estimate of covered workers Outcomes Number and incidence of claims Duration of claims Claim processing times Updated annually 2013, 2014 & ,501 ~4 to 24 months post claim NSW, VIC, QLD, WA, TAS, SA, NT, ACT & CTH schemes Standardised coding for type of condition and industry Self-reported RTW outcomes + health, employer, claim and other measures Outcomes RTW at time of interview Sustainable RTW Time taken to RTW Relapses 13

14 DATA STRENGTHS AND LIMITATIONS Strengths Very large datasets. Population coverage in case of NDS. All major workers compensation jurisdictions represented. Multiple worker, injury, demographic, claim and employer factors recorded. Standard coding schemas. Multiple RTW outcomes. Time-series. Limitations NDS is administrative data (time loss RTW) Data gaps (claims process, healthcare, psychosocial factors) Denominator data missing for some groups. NRTWS is point-in-time / cross-sectional. Coding differences between jurisdictions. Quality of data entry for NDS -?? Denominator data for most groups. 14

15 DATA PREPARATION & ANALYSIS 1. Quality Assurance Completeness / missing-ness Logic checks Outlier analysis Re-coding 3. Analytic Approaches Descriptive statistics Survival models (time to event) Interrupted time series Regression of different types 2. Derive variables Socio-economic status Remoteness Modified injury/condition types Outcome measure Study specific 15

16 COMPARE PROJECT REPORTS Reports (complete) 1. Introductory Report. 2. Work-related injury and illness in Australia. 3. Mental health related workers compensation claims in Australia. 4. The impact of legislative change on workers comp claims and outcomes. 5. Workers compensation claims among nurses and ambulance officers. Reports (underway) 1. Employer RTW plans return to work. 2. Employer response to injury and return to work. 3. Employer support for worker and return to work. 4. Impact of claims processing times on duration of time loss. 5. Long-tail workers compensation claims. 6. Claims experience of injured Australian workers & association with return to work. 7. Workers compensation claims among government sector employees. 8. Impact of changing the wage replacement cap on duration of time loss. 9. Evaluation of the 2012 NSW legislative amendment. Academic Journal Articles (published) 1. Does time off work vary after injury? A comparison of eight Australian workers compensation jurisdictions. 2. Effectiveness of employer financial incentives in reducing time to report worker injury: an interrupted time series study of two Australian workers compensation jurisdictions 3. The nature and burden of occupational injury among first responder occupations: A retrospective cohort study in Australian workers. Academic Journal Articles (submitted) 1. The impact of legislative amendments on duration of time loss following work injury: An interrupted time series analysis. 2. Sex, age, and the changing burden of work-related disability in Canada and Australia. 3. Comparing time off work after work-related mental health conditions across Australian workers compensation systems: a retrospective cohort study. 16

AUSTRALIA PARADISE FOR RTW POLICY RESEARCH Nine major variations on workers compensation policy. Regular changes in rules governing scheme activity (legislation, regulation, policy, practice).

17 AUSTRALIA PARADISE FOR RTW POLICY RESEARCH Nine major variations on workers compensation policy. Regular changes in rules governing scheme activity (legislation, regulation, policy, practice). A national minimum database of workers compensation data with a long time series. A national return to work survey of injured workers covering all workers compensation jurisdictions. A natural experiment! 17

18 STUDY 1 DOES POLICY IMPACT ON DURATION OF TIME LOSS? Standardised national cohort of 10 day + claims. 14 Median duration in weeks Unadjusted data. Large variation in median duration of time lost between jurisdictions Range from 7.8 weeks to 13.2 weeks National average = 9.2 weeks Is that statistically significant? Is it meaningful? Total NSW VIC QLD SA WA TAS NT CTH Collie A, 18Lane T, Hassani-Mahmooei B, et al. BMJ Open 2016

19 STUDY 1 SURVIVAL CURVES Data adjusted for worker, job and workplace factors. Large variation in survival patterns by jurisdiction. Effect is as large as that observed for injury type. Jurisdiction of claim has a significant impact on duration. Strongly suggests policy variation between jurisdiction is important. Collie A, Lane T, Hassani-Mahmooei B, et al. BMJ Open

20 Q. HOW OFTEN DOES POLICY CHANGE? A. OFTEN We reviewed all amendments to workers compensation legislation passed by an Act of parliament. Time period 2004 and Excluded regulation and legislation in related areas (e.g., OHS). Total of 60 changes. Minimum of 5 per jurisdiction. Some years with greater activity than others. Jurisdiction N Year N 20 CTH 7 NSW 6 VIC 8 QLD 7 WA 5 SA 6 TAS 6 NT 7 ACT 8 Total Total 60 20

21 MONASH MEDICINE, NURSING & HEALTH SCIENCES Thank you! Please feel free to make contact with our research group or view our website. 21

Employer Support for Making a Workers Compensation Claim: Overview and Association with Return to Work.

MONASH MEDICINE, NURSING & HEALTH SCIENCES Employer Support for Making a Workers Compensation Claim: Overview and Association with Return to Work. COMPARE Project Team April 2018 Acknowledgments The COMPARE